Computer assisted semen analyzers in andrology research and veterinary practice

Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy. Fortunately, the reported prevalence of the severe form of OHSS is small, ranging from 0.5 to 5%. Nevertheless, as this is an iatrogenic complication of a non-vital treatment with a potentially fatal outcome, the syndrome remains a serious problem for specialists dealing with infertility. The aim of this literature review was to determine whether it is possible to identify patients at risk, and which preventive method should be applied when an exaggerated ovarian response occurs. Data pertaining to the epidemiology and prevention of OHSS in women were searched using Medline, Current Contents and PubMed, and are summarized. Preventive strategies attempt either to limit the dose or concentration of hCG or to find a way to induce luteolysis without inducing a detrimental effect on endometrial and oocyte quality. The following particular preventive strategies were reviewed: cancelling the cycle; coasting; early unilateral ovarian follicular aspiration (EUFA); modifying the methods of ovulation triggering; administration of glucocorticoids, macromolecules and progesterone; cryopreservation of all embryos; and electrocautery or laser vaporization of one or both ovaries.

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Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review

Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment.

I. Introduction II. Dynamics of Normal Human Follicle Growth and Selection A. Gonadotropin-independent and -dependent follicle growth B. Intrafollicular endocrine changes C. Are estrogens needed for follicle development? D. In vivo regulation of follicle maturation in the monkey E. The FSH threshold and window concept for in vivo follicle growth 1. FSH threshold and follicle recruitment 2. FSH window and single dominant follicle selection 3. Dominant follicle development F. Modulation of FSH action 1. Heterogeneity of FSH 2. Direct interference with FSH action 3. Intraovarian interference with FSH action by growth factors III. Gonadotropin Induction of Ovulation A. The concept of monofollicle growth in anovulatory patients B. Conditions affecting treatment outcome 1. Patient-related factors 2. Hormone preparation-related factors 3. Other factors involved C. Commonly used step-up dose regimens 1. Conventional step-up protocol 2. Low-dose, step-up protocol D. Potential for a step-down dose regimen IV. Stero...

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Manipulation of Human Ovarian Function: Physiological Concepts and Clinical Consequences

15. 14. Ogedengbe OK, Giwa-Osagie OF, Ogunyemi O. Implications of pattern of tubal disease for microsurgery and in-vitro fertilisation in Lagos. Journal of the National Medical Association , 1987, 79:510–512.

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Current Practices and Controversies in Assisted Reproduction

Severe ovarian hyperstimulation syndrome using agonists of gonadotropin-releasing hormone for in vitro fertilization: a European series and a proposal for prevention.

The effect of the strict classification of spermatozoal morphology on the outcome of in-vitro fertilization and embryo transfer treatment cycles has been assessed in a retrospective analysis of 2144 consecutive cycles. The patients all had a standardized long protocol gonadotrophin-releasing hormone analogue cycle, with luteal phase start, to achieve down-regulation. All treatment cycles where the sperm density was abnormal ( 14% normal forms, and group 2 with > or = 4%, < or = 14% normal forms). There was a statistically significantly lower chance of achieving this rate in patients of group 3 (< 4% normal forms) (P < 0.005), but 68.6% did achieve that fertilization rate or higher. There was no statistically significant difference in any of the other end points. In conclusion, a morphological classification may be appropriate as an indicator for counselling patients with regard to treatment expectations, but its use would be seem inappropriate as an index of fertilizing potential in clinical management.(ABSTRACT TRUNCATED AT 250 WORDS)

Does isolated teratozoospermia affect performance in in-vitro fertilization and embryo transfer ?

An anonymous questionnaire was circulated at two gamete donation clinics to survey the attitudes of donor insemination patients (n = 71; 89% response rate), sperm donors (n = 52; 85% response rate) and ovum donors (n = 5; 63% response rate) to the release of medical records with non-identifying information, or with identifying information of the donor involved. The majority of established sperm donors agreed to the release of medical records with or without identifying information. In the subset of potential sperm donors 85% would not enter a sperm donation programme unless anonymity was maintained, but 60% would agree to the release of non-identifying medical records. Sixty per cent of recipients of donated spermatozoa would agree to the release of medical records with identifying information of the donor, but 85% stated that they would not tell their children of their genetic origin. There is a significant difference between the attitudes of potential sperm donor recruits to these questions and those of established donors and recipients of donated spermatozoa. In conclusion, the results of this survey show that although established sperm donors would continue to donate spermatozoa if their status of anonymity was withdrawn, recruitment of new donors would be significantly reduced. This would be to the detriment of gamete donation programmes and to the subfertile couples who request this form of treatment.

Attitudes of donors and recipients to gamete donation

This prospective study demonstrates the feasibility and outcome of embryo transfer performed by nursing staff with medical cover available. Of 771 patients who had embryo transfer, 679 (88%) had their embryo transfer performed by a nurse. In 92 cases (12%) a doctor performed the embryo transfer, either as the first operator, or having been brought in to assist the nurse who experienced difficulty. The pregnancies per transfer for nurse transfer was 246/679 (36%) and where a doctor performed the transfer 20/68 (29%). These data show a high comparable success rate when a nurse performed the embryo transfer, and a low incidence of direct medical involvement.

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Declan Egan

Papers

Severe ovarian hyperstimulation syndrome using agonists of gonadotropin-releasing hormone for in vitro fertilization: a European series and a proposal for prevention.

Does isolated teratozoospermia affect performance in in-vitro fertilization and embryo transfer ?

Attitudes of donors and recipients to gamete donation

Nurses performing embryo transfer: successful outcome of in-vitro fertilization.

What is the true follicular diameter: an assessment of the reproducibility of transvaginal ultrasound monitoring in stimulated cycles.